CMS Proposes Value-Based Purchasing Rule

The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule providing for additional pathways to “value-based purchasing” for prescription treatments. The rule proposes a definition of value-based purchasing as: 

“an arrangement or agreement intended to align pricing and/or payments to an observed or expected therapeutic or clinical value in a population (that is, outcomes relative to costs) and includes (but is not limited to):
 
  • Evidence-based measures, which substantially link the cost of a drug to existing evidence of the effectiveness or potential value for specific uses of that product, and/or,
 
  • Outcomes-based measures, which substantially link payment for the drug to that of the drug’s actual performance in a patient or a population, or a reduction in other medical expenses

Noting that CMS has approved some state value-based purchasing agreements via supplemental rebates, the proposed rule would update Medicaid “Best Price” rules to allow for modifications based on value-based purchasing agreements for more than the currently allowed three years. 

BioNJ believes in the value of medical innovation, and we support proposals aimed at improving continued access to new and innovative therapies. Stay tuned for additional information on yesterday’s proposed rule. Please contact John Slotman, BioNJ’s VP of Government Affairs, JSlotman@BioNJ.org with any questions.  

Click here to read more about the proposed rule. 

Click here to read a blog from CMS Administration Seema Verma.
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